Conclusion The arterial lactate and venous lactate levels were strongly correlated in the condition of sepsis or septic shock. Consequently, V-LACT may be used in substitution for A-LACT particularly in lactate levels not higher than 4 mmol/l. However, trending should be generally applied instead of the absolute value.
Table 1 (abstract P176). Baseline characteristics in SS and ShS patients by quartiles of blood LT
Lactate <1.87 (n = 33) Lactate 1.88 to 2.69 (n = 41) Lactate 2.7 to 4.06 (n = 34) Lactate>4.07 (n = 37) P value
Age (years) 57 (45 to 71) 64 (51.5 to 74.5) 65 (48 to 69) 60 (48.5 to 71) NS
APACHE II 25 (18.5 to 30) 25 (19.5 to 27) 25 (21.5 to 29.5) 27 (22 to 33) 0.04
SOFA 9 (7 to 10.5) 9 (7 to 11) 9 (8 to 11) 11(8 to 13) 0.024
NOF 3 (3 to 4) 3 (3 to 4) 4 (3 to 5) 5 (3.5 to 5) <0.001
LT (mmol/l) 1.43 (1.16 to 1.56) 2.2 (1.99 to 2.47) 3.34 (3 to 3.72) 5.1 (4.4 to 7.34) <0.001 Procalcitonin (ng/ml) 2.81 (0.76 to 20.7) 11.5 (2.88 to 37.15) 13.47 (1.91 to 42.1) 21.6 (5.2 to 5.8) 0.05 Cholesterol (mg/dl) 127 (97.5 to 165) 130 (95.5 to 152.5) 100 (72 to 128) 91 (79 to 116.7) 0.06
28-day mortality (%) 10.8 21.2 24.4 35.1 0.029
ShS (%) 83.8 85.4 81.1 87.9 NS
Figure 1 (abstract P177).
Figure 2 (abstract P177).
P178
Comparison of the eff ects of histidine–triptophan–ketoglutarate solution and crystalloid cardioplegia on myocardial protection during pediatric cardiac surgery
S Kuslu, P Zeyneloglu, A Pirat, A Camkiran, M Ozkan, G Arslan Baskent University Faculty of Medicine, Ankara, Turkey Critical Care 2014, 18(Suppl 1):P178 (doi: 10.1186/cc13368)
Introduction The major components of myocardial protection during cardiac surgery are the combination of cardioplegia solutions with hypothermia. The primary endpoint of this study is to compare the eff ects of histidine–triptophan–ketoglutarate (HTK) solution and crystalloid cardioplegia on release of cardiac troponin-I (cTn-I) and creatine kinase-myocardial band (CK-MB), which are perioperative determinants of myocardial protection; the secondary endpoint is to evaluate the intraoperative and postoperative hemodynamic variables and clinical outcome parameters.
Methods A total of 66 children aged 1 month to 6 years undergoing elective congenital heart surgery were randomly allocated to HTK solution (Group H, n = 32) or crystalloid cardioplegia (Group C, n = 34) after aortic cross-clamping. Blood samples for cTn-I and CK-MB levels were measured before the surgical incision, at the end of surgery and at 4, 16, 24 and 48 hours postoperatively.
Results Demographic features were similar in both groups. Duration of surgery, aortic clamp and cardiopulmonary bypass times, amounts of intraoperative fl uids used and urine outputs were similar between the groups. The groups were not signifi cantly diff erent in terms of cTn-I and CK-MB levels at the intraoperative and postoperative period (P >0.05 for all). The dose of positive inotropic drug at the end of surgery was signifi cantly high in Group H (P = 0.01). The requirements for defi brillation were similar in both groups. There were no signifi cant diff erences between the groups regarding postoperative hemodynamic parameters, positive inotropic requirements, amounts of fl uids and blood given and pacemaker requirements (P >0.05 for all).
Duration of mechanical ventilation, lengths of ICU and hospital stay were similar in both groups.
Conclusion The present study demonstrated that there is no superiority of HTK solution and crystalloid cardioplegia to each other for myocardial protection during pediatric cardiac surgery.
P179
Hyperdynamic ejection fraction in the critically ill patient JR Paonessa1, TP Brennan2, LA Celi1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2Massachusetts Institute of Technology, Cambridge, MA, USA Critical Care 2014, 18(Suppl 1):P179 (doi: 10.1186/cc13369)
Introduction The hyperdynamic left ventricular ejection fraction (HDLVEF) in the ICU is a common fi nding thought to be associated with critical illness and possibly sepsis. The exact etiology of hyperdynamic ejection fraction has yet to be determined, and the prognosis of these patients has not been well defi ned.
Methods The cohort consisted of 2,632 adults admitted to the ICU with echocardiogram reports using the MIMIC-II database, and was divided into those with HDLVEF and those with normal left ventricular ejection fraction (NLVEF). Those with impaired ejection fraction were excluded from the analysis. Baseline comparisons were performed using chi- squared tests for equal proportion with results reported as numbers, percentages, and 95% CIs. Continuous variables were compared using t tests and reported as means with 95% CIs, while non-normally distributed data were compared using Wilcoxon rank-sum tests and reported as medians.
Results Patients with HDLVEF had increased mortality in hospital, at 28 days and at 1 year when compared with patients with NLVEF.
HDLVEF patients more frequently required renal replacement therapy (RRT), vasopressors and mechanical ventilation. Of the 2,632 patients, 1,220 were septic. There was an increased proportion of HDLVEF in the septic compared with the nonseptic groups (11.2% vs. 8.6%, P = 0.026).
Interestingly, other statistically signifi cant associated comorbidities were cancer, CHF, arrhythmias, and hypertension, which were more commonly seen in the HDLVEF group. See Table 1.
Table 1 (abstract P179)
Normal Hyperdynamic
(n = 2,373, 90%) (n = 259, 10%) P value
Male 1,159 (49) 98 (38) <0.001
Service type
MICU 1,234 (52) 138 (53) 0.695
CCU 364 (15) 28 (11) 0.052
SICU 572 (24) 69 (27) 0.367
CSRU 188 (8) 23 (9) 0.590
Primary outcome
Twenty-eight-day mortality 458 (19) 79 (31) <0.001 One-year mortality 892 (38) 129 (50) <0.001 ICU mortality 296 (12) 60 (23) <0.001 Hospital mortality 433 (18) 80 (31) <0.001 Treatment
RRT 363 (15) 55 (21) 0.013
Vasopressor 1,063 (45) 139 (54) 0.006
Ventilated 1,453 (61) 186 (72) <0.001
Conclusion Patients with hyperdynamic LVEF in the ICU clearly have increased mortality. Hyperdynamic LVEF may be a result of increased catecholamines during cytokine storm. It is unclear whether hyperdynamic LVEF itself worsens outcomes. Further investigation is needed.
P180
Impact of nitric oxide on pulmonary regurgitation and cardiac function in the acute stage after right ventricular outfl ow surgery Y Ko, K Morita, R Nagahori, T Abe, K Hashimoto
Jikei University School of Medicine, Tokyo, Japan
Critical Care 2014, 18(Suppl 1):P180 (doi: 10.1186/cc13370)
Introduction Pulmonary regurgitation (PR) that develops after right ventricular (RV) outfl ow reconstruction including the Rastelli and Norwood procedure may often result in serious cardiac events early after surgery. We hypothesized that PR may be associated with pulmonary vascular resistance (PVR) and RV contraction. Accordingly, we assessed the impact of PVR on PR and RV function using a swine model.
Methods Eight pigs (14 ± 2 kg) underwent total resection of the pulmonary valve cusps under cardiopulmonary bypass (PR group).
This was compared with a control group (n = 6) that underwent only bypass. In both groups, the pulmonary regurgitant fraction (PRF) and cardiac output were measured by a pulsed Doppler fl ow meter, and the percent segmental shortening of RV (%RVSS) and RV end-diastolic dimension (RVDd) were measured by sonomicrometry. We also performed dobutamine stress evaluation as well as changing the PVR by carbon dioxide (PaCO2) and inhaled nitric oxide (NO).
Results All bypass time was 18 ± 3 minutes. In the PR group, the PRF was 40 ± 4% and the RVDd was 53 ± 9 mm* (vs. control 34 ± 6 mm). *P <0.05.
A signifi cant reduction in the %RVSS (18 ± 1%* vs. control 22 ± 1%) and the cardiac output (2.1 ± 0.2 l/minute* vs. control 2.5 ± 0.3 l/minute) were observed. The PRFs were 60 ± 5% (PaCO2 >80 mmHg), 37 ± 2%
(PaCO2 <20 mmHg), 24 ± 2% (NO 20 ppm; PaCO2 40 mmHg), and were positively correlated with the PVR (Figure 1A). During the dobutamine stress, the %RVSS was increased (baseline 18 ± 1%, 5γ 21 ± 2%, 10γ 26 ± 3%), and was negatively correlated with the PRFs (Figure 1B).
Conclusion These results indicated that massive PR resulted in marked deterioration of RV performance; however, low PVR and high RV contractility may contribute to reduce the severity of PR and improve cardiac function. Nitric oxide may be a useful treatment modality the
same as catecholamine during the acute stage after RV outfl ow surgery with PR.
P181
Cardiogenic oscillation in pediatric patients after cardiac surgery H Imanaka, N Okuda, T Itagaki, M Onodera, M Nishimura
Tokushima University Hospital, Tokushima, Japan
Critical Care 2014, 18(Suppl 1):P181 (doi: 10.1186/cc13371)
Introduction Cardiogenic oscillation is the fl uctuation in fl ow tracing in mechanically ventilated patients. Large cardiogenic oscillation may cause autotriggering in adult patients after cardiac surgery [1]
and inaccurate volume monitoring [2]. However, it is unknown how cardiogenic oscillation is problematic in pediatric patients. Therefore, we prospectively surveyed cardiogenic oscillation in pediatric patients after cardiac surgery.
Methods We enrolled 17 pediatric patients who underwent cardiac surgery using cardiopulmonary bypass. They were mechanically ventilated with pressure-controlled ventilation. We measured the amplitude in cardiogenic oscillation and compared them between their admission to the ICU and before extubation. We performed statistical analysis with the t test and considered P <0.05 signifi cant.
Results Cardiogenic oscillation was 2.1 ± 0.6 l/minute just after the surgery (Figure 1). Autotriggering occurred in seven of 17 patients when triggering sensitivity was set at 1 l/minute. Before the extubation, cardiogenic oscillation signifi cantly decreased to 1.4 ± 0.4 l/minute when autotriggering disappeared. Intensive care including adjustment
of inotropes and intravascular volume might have contributed to the decrease in cardiogenic oscillation.
Conclusion In pediatric patients after cardiac surgery, cardiogenic oscillation was initially large but was decreasing at the extubation.
References
1. Crit Care Med 2000, 28:402.
2. Crit Care Med 2004, 32:1546.
P182
Intraoperative dexamethasone on left atrial function and postoperative atrial fi brillation in cardiac surgical patients K Jacob, S Dieleman, H Nathoe, D Van Osch, E De Waal, M Cramer, J Kluin, D Van Dijk
Utrecht University Medical Center, Utrecht, the Netherlands Critical Care 2014, 18(Suppl 1):P182 (doi: 10.1186/cc13372)
Introduction Postoperative new-onset atrial fi brillation (PNAF) is very common after cardiac surgery. The infl ammatory response due to surgery and cardiopulmonary bypass (CPB) may contribute to PNAF by inducing atrial dysfunction [1]. Corticosteroids reduce the infl ammatory response and may thus reduce atrial dysfunction and PNAF [2]. The aim of this study was to determine whether dexamethasone protects from left atrial dysfunction and PNAF in cardiac surgical patients.
Methods Patients undergoing cardiac surgery were randomized to a single dose of dexamethasone (1 mg/kg) or placebo after inducing anesthesia. Transesophageal echocardiography was performed in patients after CPB. The primary outcome was left atrial total ejection fraction (LA-TEF) after sternal closure; secondary outcomes included left atrial diameter and PNAF, detected by Holter monitoring.
Results Sixty-two patients were included. Baseline characteristics were well balanced. Postoperative LA-TEF was 36.4% in the dexamethasone group and 40.2% in the placebo group (P = 0.15) (Figure 1). Secondary echocardiographic outcomes were also insignifi cant (Table 1). The incidence of PNAF was 30% in the dexamethasone group and 39% in the placebo group (P = 0.47).
Table 1 (abstract P182). Secondary postoperative echocardiographic parameters in both groups
Parameter Dexamethasone Placebo P value
LA-TEF 36.4 40.2 0.15
LA diameter 4.6 4.3 0.19
LA area 16.0 16.4 0.81
Conclusion Intraoperative high-dose dexamethasone did not have any protective eff ect on postoperative LA-TEF or dimension and did not reduce the risk of PNAF in cardiac surgical patients.
Figure 1 (abstract P180).
Figure 1 (abstract P181). Cardiogenic oscillation.
Figure 1 (abstract P182). Primary outcome preoperatively and postoperatively in dexamethasone and placebo groups.
References
1. Haff ajee et al.: JACC Cardiovasc Imaging 2011, 4:833-840.
2. Chaney et al.: Chest 2002, 121:921-923.
P183
White blood cell count and new-onset atrial fi brillation after cardiac surgery
S Dieleman, K Jacob, H Nathoe, M Ten Berg, D Van Osch, J Frencken, D Van Dijk
Utrecht University Medical Center, Utrecht, the Netherlands Critical Care 2014, 18(Suppl 1):P183 (doi: 10.1186/cc13373)
Introduction Postoperative new-onset atrial fi brillation (PNAF) is the most common complication after cardiac surgery. Infl ammation as an underlying mechanism has been studied by various infl ammatory markers, and white blood cell count (WBC) is the only present consequent infl ammatory marker predicting PNAF [1]. This study aimed to determine the association between perioperative WBC and PNAF.
Methods Patients >18 years undergoing elective cardiac surgery with a sinus rhythm preoperatively were recruited from the Dexamethasone for Cardiac Surgery-PNAF trial for this post-hoc cohort study. The WBC was prospectively measured preoperatively and once during each of the fi rst four postoperative days. Development of PNAF was evaluated with continuous 12-lead ECG monitoring the fi rst 5 days postoperatively.
Results A total of 657 patients were included in this trial, 277 developed PNAF. The WBC was signifi cantly higher in the PNAF group on day 2 and day 4 (Figure 1). However, multivariate analysis showed that preoperative and postoperative WBC, days 1 to 3, were not associated with PNAF (Table 1). Older age (OR: 1.05; CI: 1.03 to 1.07; P <0.001), CABG plus valve surgery (OR: 2.95; CI: 1.78 to 4.88), single valve surgery (OR: 3.09; CI: 2.03 to 4.69; P <0.001) and other surgery (OR: 2.21; CI: 1.23 to 3.97; P <0.001) were correlated with the occurrence of PNAF.
Table 1 (abstract P183). Multiple regression analysis of association between high WBC and developing PNAF
Time point OR 95% CI
Baseline 1.04 0.96 to 1.13
Day 1 1.03 0.98 to 1.08
Day 2 1.03 0.99 to 1.08
Day 3 1.03 0.96 to 1.11
Day 4 1.09 1.01 to 1.16
Conclusion Preoperative and postoperative WBC were not associated with development of PNAF.
Reference
1. Abdelahdi et al.: Am J Cardiol 2004, 93:1176-1178.
P184
Anti-adrenergic eff ects of ranolazine in isolated rat aorta P Marchio, MD Mauricio, FB El Amrani, S Guerra, D Aguirre-Rueda, SL Vallés, JM Vila, M Aldasoro
University of Valencia, Spain
Critical Care 2014, 18(Suppl 1):P184 (doi: 10.1186/cc13374)
Introduction Ranolazine, a piperazine derivative, is used as an anti- anginal drug to treat patients with chronic angina in clinical practice [1]
and may improve coronary blood fl ow by reducing compression eff ects of ischemic contracture, and by improving endothelial function [2,3].
In the present study we investigate the vascular eff ects of ranolazine on the endothelium, adrenergic system and Ca2+ in isolated rat aorta.
Methods Rat aortic segments (3 mm long) with and without endothelium were mounted for isometric tension recording in organ baths containing Krebs–Henseleit solution. Electrical fi eld stimulation (2, 4 and 8 Hz, 20 V, 0.25 ms duration for 30 seconds) was provided by a Grass S88 stimulator via two platinum electrodes positioned on each side and parallel to the axis of the aortic segment. Concentration–
response curves of ranolazine (10–7 to 10–4 M) were obtained in a cumulative manner using endothelin-1, noradrenaline, thromboxane A2 and KCl as constrictor agents.
Results The contractile responses to electrical fi eld stimulation were abolished by tetrodotoxin, guanethidine and prazosin, indicating that the contractile eff ect is due to the action of noradrenaline on alpha adrenoreceptors. Ranolazine diminished (P <0.05) neurogenic adrenergic contractions induced by electrical fi eld stimulation in aortic rings with and without endothelium. Ranolazine produced concentration-dependent relaxation in rings precontracted with noradrenaline (Emax 86 ± 6%, n = 10; P <0.05) but not in rings precontracted with endothelin-1, thromboxane A2 and KCl. Neither L-NAME (10–4 M), an inhibitor of nitric oxide synthase, nor indomethacin (10–5 M), an inhibitor of cyclooxygenase, modifi ed the relaxation induced by ranolazine. The calcium antagonist nifedipine (10–6 M) reduced the relaxation induced by ranolazine.
Conclusion These results indicate that ranolazine diminished the contractile response induced by adrenergic stimulation, suggesting an eff ect as an adrenergic blocker. The relaxant eff ects of ranolazine on rat aortic vessels is not dependent on the endothelium-derived factors (nitric oxide or dilator prostanoids) but involves an interference with the entry of calcium through dihydropyridine calcium channels.
References
1. Chaitman BR.: Circulation 2006, 113:2462-2472.
2. Stone PH, et al.: J Am Coll Cardiol 2010, 56:934-942.
3. Deshmukh SH, et al.: Coron Artery Dis 2009, 20:343-347.
P185
Delays in extubation following elective adult cardiac surgery J Parmar, J Clarke, G Lau, R Porter, C Allsager
Glenfi eld Hospital, University Hospitals of Leicester, UK Critical Care 2014, 18(Suppl 1):P185 (doi: 10.1186/cc13375)
Introduction Early extubation post coronary artery bypass grafting does not increase perioperative morbidity and reduces the length of stay (LOS) in the ICU and in hospital [1]. Use of low-dose opioid- based general anaesthesia and time-directed protocols for fast- track interventions does not increase mortality or postoperative complications in low–moderate-risk patients and has been found to have a reduced time to extubation and shortened ICU stay [2]. Our mean time to extubation is 6 hours, although patients are assessed to be safe to be weaned from mechanical ventilation at 2 hours following arrival in the ICU. This study aims to identify factors that delay extubation in patients undergoing routine cardiac surgery at our institution.
Methods A prospective analysis was performed on all patients post adult cardiac surgery from 14 May 2013 to 10 July 2013. Emergency surgical patients and those with intraoperative complications were excluded.
Results A two-sample t test was used to analyse the data. Patient demographics are presented in Table 1. There were signifi cant delays in time of extubation in those who received morphine prior to extubation compared with those that did not (P = 0.0184) (Table 2). There were no Figure 1 (abstract P183). WBC at baseline (t = 0) and in the four
postoperative days (t = 1 to 4), PNAF versus no PNAF.
signifi cant diff erences in LOS in ICU or hospital. Factors such as age, EUROSCORE and type of operation did not have an infl uence on time to extubation.
Conclusion Administering morphine prior to extubation causes signifi cant delays in weaning from mechanical ventilation. We plan to introduce intraoperative and postoperative protocols to facilitate rapid weaning from mechanical ventilation for elective cardiac surgical patients.
References
1. Cheng DC, et al.: J Thorac Cardiovasc Surg 1996, 112:755-764.
2. Zhu F, et al.: Cochrane Database 2012, 10:CD003587.
P186
Eff ects of perfusion pressure on the splanchnic circulation after cardiopulmonary bypass: a randomized double cross-over study L McNicol1, M Lipcsey2, R Bellomo1, F Parker1, S Poustie1, G Liu1, S Uchino3, A Kattula1
1Austin Hospital, Heidelberg, Australia; 2Uppsala University, Uppsala, Sweden;
3Jikei University, Tokyo, Japan
Critical Care 2014, 18(Suppl 1):P186 (doi: 10.1186/cc13376)
Introduction No randomized trial has assessed the eff ects of diff erent mean arterial pressure (MAP) targets in postcardiac surgery intensive care. We investigated the short-term eff ects of MAP of 65 or 85 mmHg on splanchnic oxygen fl ux, metabolic function, mucosal perfusion and cytokine regulation.
Methods A single-center, randomized controlled, double cross-over trial was performed. Patients were randomized to: HLH (high–low–
high) where MAP targets were 85–65–85 mmHg in sequence, with each lasting 2 hours, or LHL (low–high–low) where MAP targets were 65–
85–65 mmHg. Blood pressure was adjusted with noradrenalin infusion.
Results Six + six patients were included in the study. MAP targets were achieved in all patients at all time points (64 ± 3, 84 ± 4; 65 ± 5 mmHg in the LHL group and 84 ± 3; 66 ± 2; 85 ± 5 mmHg in the HLH group at the fi rst, second and third time points), with corresponding changes in fi lling pressures. Cardiac output did not change over time. Hepatic venous saturation was 41 ± 15; 58 ± 24; 56 ± 21% in the LHL group and 50 ± 19; 43 ± 20; 41 ± 18% in the HLH group at the fi rst, second and third time points, with a signifi cant time group interaction (P <0.05). No changes were observed in global or trans-splanchnic lactate levels and cytokine levels or in gastric tonometry CO2.
Conclusion Increasing MAP with norepinephrine has some eff ects splanchnic oxygenation, but has no impact on metabolic or biochemical function and key cytokine removal or release. MAP targets of 60 to 65 mmHg or 80 to 85 mmHg appear physiologically equivalent for the splanchnic circulation.
P187
Isofl urane attenuates left ventricular akinesia and preserves cardiac output in the Tako-tsubo rat model
J Oras1, B Redfors2, Y Shao2, H Seeman-Lodding1, SE Ricksten1, E Omerovic2
1Institute of Clinical Sciences, Gothenburg, Sweden; 2The Wallenberg Laboratory, Gothenburg, Sweden
Critical Care 2014, 18(Suppl 1):P187 (doi: 10.1186/cc13377)
Introduction Tako-tsubo cardiomyopathy (TCM) is an acute cardiac syndrome with regional hypokinesia in the left ventricle (LV), often
aff ecting the apex causing apical ballooning. TCM is frequent in patients with adrenergic overstimulation and is probably common in ICU patients [1]. In a TCM rat model we evaluated whether diff erent anesthetic agents could attenuate LV akinesia in TCM.
Methods Isoprenaline was intraperitoneal (i.p.) injected, which induces LV akinesia and apical ballooning within 90 minutes [2]. We performed the study in two diff erent settings. In the fi rst setting, spontaneously breathing rats (n = 12 in each group) were sedated with either pentobarbital, ketamine, isofl urane or no anesthetic before i.p.
isoprenaline. One additional group received the K-ATP blocker glyburide before sedation with isofl urane. In the second setting, rats were anaesthetized with ketamine + midazolam, mechanically ventilated and the carotid artery was cannulated. Before i.p. isoprenaline, animals were randomized to either no isofl urane (0 MAC), isofl urane 0.5 MAC or isofl urane 1.0 MAC (n = 12 in each group). Arterial blood gas was obtained before isoprenaline and 60 minutes after isoprenaline. The heart rate (HR), systolic blood pressure (SBP) and body temperature (BT) were recorded continuously. After 90 minutes, echocardiography was performed. Extent of akinesia was expressed as the percentage of total LV endocardial length. End-diastolic and end-systolic LV volumes were measured, and stroke volume (SV) and cardiac output (CO) were calculated.
Results In spontaneously breathing rats, the degree of akinesia was signifi cantly lower with pentobarbital and isofl urane (± glyburide) but not with ketamine compared with controls. The degree of akinesia was lowest with isofl urane. In ventilated rats, the degree of apical akinesia (%) was signifi cantly lower at 0.5 MAC (8.7 ± 7.3) and 1 MAC (5.7 ± 7.4) versus 0 MAC (17.7 ± 8.0). This was accompanied by a higher CO and SV. HR was lower at 1 MAC (6%) and SBP was lower at 0.5 MAC (106 ± 7) and 1 MAC (98 ± 7) versus 0 MAC (126 ± 8). BT and pH was lower in both isofl urane groups. In a multivariate model, isofl urane was the only variable that was independently associated with the degree of LV akinesia.
Conclusion Isofl urane prevents experimental TCM and preserves LV function, an eff ect not mediated via opening of K-ATP channels. The eff ect cannot be explained entirely by attenuation of myocardial stress. Isofl urane sedation in the ICU might be an interesting approach for patients suff ering from hyperadrenergic conditions at risk of developing TCM.
References
1. Park JH, et al.: Chest 2005, 128:296-302.
2. ShaoY, et al.: Int J Cardiol 2013, 168:1943-1950.
P188
Preoperative therapy with angiotensin-converting enzyme inhibitors in cardiac surgery patients: is there any impact on postoperative renal function?
F Ampatzidou, M Sileli, K Diplaris, C Koutsogiannidis, T Karaiskos, G Drossos
General Hospital ‘G. Papanikolaou’, Thessaloniki, Greece Critical Care 2014, 18(Suppl 1):P188 (doi: 10.1186/cc13378)
Introduction Preoperative therapy with angiotensin-converting enzyme inhibitors (ACEI) is common in patients undergoing cardiac surgery. The aim of this study was to evaluate the still-debated impact of preoperative use of ACEI on postoperative renal function in cardiac surgery patients [1,2].
Methods A total of 624 consecutive patients, who underwent cardiac surgery from July 2012 to October 2013, were evaluated. Data were prospectively collected in our clinic’s electronic database and were retrospectively analyzed as to preoperative ACEI therapy. The chi- square test was used for correlations. Endpoints of the study were the development of postoperative acute kidney injury (AKI) and the diff erence between hospital admission and discharge glomerular fi ltration rate (GFR). The AKI defi nition was based on modifi ed RIFLE classifi cation. GFR values were estimated by the MDRD formula.
Results A total of 354 patients (56.7%) were treated with ACEI preoperatively. Overall, 95 patients (15.3%) developed postoperative AKI. Preoperative use of ACEI was not associated with the development Table 1 (abstract P185). Patient demographics
Age (years) 66 (10.1)
EUROSCORE (%) 2.90 (1.84)
Table 2 (abstract P185). Morphine versus no morphine
Morphine No morphine
Patient number 51 20
Time to extubation (hours) 7:48 (4:42) 4:48 (2:19) LOS ICU (hours) 51:21 (55:16) 40:06 (28:47) LOS hospital (days) 9.83 (5.01) 10.8 (13.5)